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Claims Support Specialist
3 months ago
Late Shift:
(10:25 :00 )
Up to 2 Permanent Positions
Serves as the main contact for addressing and resolving inquiries related to claims and coverage from workers, employers, representatives, healthcare providers, and other service entities received in the Claims Service Centre or when Adjudicators or Case Managers are unavailable.
Key Responsibilities:
The Claims Service Representative is tasked with initiating new claim files, confirming Workers Compensation coverage, accepting specific no time loss claims, and guiding each inquiry to a resolution that ensures customer satisfaction while adhering to organizational standards and objectives.
Employs effective listening and questioning techniques to ascertain each customer's needs; identifies, evaluates, and determines alternatives to resolve issues.If unable to resolve an inquiry before the call concludes, takes necessary steps for resolution immediately after the call or coordinates with an Adjudicator or Case Manager for timely resolution.
Follows established protocols to create new claim files, input data, search the database, and verify and collect information by contacting injured workers, employers, and healthcare providers.
Notifies the relevant internal parties at the time of reporting a serious accident or fatality.Adheres to departmental standards for gathering, reviewing, and assessing information to establish Workers Compensation coverage for new claims, communicating decisions to affected parties when appropriate, and referring to the Supervisor or Assessment Services when further action is required.
Accepts no time loss claims (Complexity A) within defined parameters. Claims needing further investigation or approval are forwarded to Adjudicators for assessment.
Utilizes each inquiry as an opportunity to address customer concerns and anticipate future needs, reviewing outstanding or upcoming claim file tasks when suitable.
Identifies workers in distress and refers them to an appropriate WCB resource.
Reviews the claim file and approves medical expenses within specified guidelines and authority levels. Manages claim owner approved wage loss matters. Refers inquiries that are highly unusual, complex, or exceed authority levels to the appropriate Adjudicator or Case Manager.
Updates claim files as part of each call; meticulously documents customer interactions including any information gathered, entitlement decisions made, actions taken, and claim tasks created.
Provides coverage at the main reception desk.
Completes statistical coding of claims within quality and timeliness standards.
Performs other related duties as assigned.
Qualifications:
Completion of a two (2) year diploma in a related field (Business Administration)
Minimum two (2) years' experience interpreting and applying processes and procedures to manage and resolve customer inquiries/concerns
Typing speed of 35 (error rate less than 5%)
Knowledge of customer service principles and practices
Proficiency in the use of personal computers and software in a Windows environment
Excellent customer service skills including the ability to manage potentially confrontational situations with tact and diplomacy
Well-developed verbal and written communication skills to engage with internal and external stakeholders
Ability to interpret and apply processes and procedures including those related to WCB Adjudication and Case Management
Ability to obtain, assess, and evaluate information through claim file review, listening, and/or questioning to problem solve and support decision making
Ability to perform detailed and accurate work in a fast-paced environment
Ability to work independently and collaboratively as part of a team
Customer service experience in a call centre environment including knowledge of call centre telephony and technology would be an asset
Knowledge of advanced communication skills such as active listening and de-escalation techniques would be an asset
Additional Information:
Salary Range:
$55,684 - $69,603
The Claims Service Representative (CSR) is an introductory position that provides the knowledge and experience necessary to transition into various roles within the WCB.
The WCB is committed to career development and promoting from within, with many CSRs beginning their WCB career in this role.
A satisfactory criminal record check and verification of education will be required for the successful candidate.
The WCB is dedicated to building a skilled, diverse workforce with equitable representation of Indigenous persons, visible minorities, persons with disabilities, women, LGBTTSQ+ persons, and members of other equity-seeking groups.
The WCB recognizes that individuals may face barriers that hinder their full and equal participation in the workplace and is committed to providing reasonable accommodation to all employees and candidates who are or may be disabled by one or more barriers in the workplace.
Accommodations are available on request for candidates participating in all aspects of the selection process.ABOUT WCB:
The Workers Compensation Board promotes safety and health in Manitoba workplaces and aims to help prevent and reduce the occurrence of workplace injuries and disease.
Working with its partners, the WCB promotes safe and healthy workplaces, facilitates recovery and return to work, provides compassionate and supportive compensation services for workers and employers, and ensures responsible financial stewardship.
WCB encompasses what it means to work at the WCB.
The WCB is proud to offer employee benefits and programs that support financial and personal security, foster health and well-being, encourage involvement, and support growth as an individual and member of the WCB community.
The four categories of WCB include:
Security, Wellness, Engagement, and Growth.
